Menopause Rx: The Heart of the Matter

Hormone replacement therapy after menopause found not to protect women against heart disease

(RxWiki News) The use of hormones during menopause was once thought to protect against heart disease, but that may not be the case.

Menopausal symptoms can be very disruptive. Some women choose to manage the worst of the symptoms with hormone replacement therapy (HRT). However, a new and extensive review of the available literature found that HRT did not protect postmenopausal women from heart disease. In some women, it may even increase the risk of stroke.

Dr. Henry M. P. Boardman, of the Department of Cardiovascular Medicine at the University of Oxford, led this study.

"When we looked at the results according to the age of women, or by how long since their menopause that they started treatment, we found that if 1000 women under 60 years old started hormone therapy we would expect six fewer deaths, eight fewer cases of heart disease and five extra blood clots over about seven years, compared to 1000 similar women who did not start hormone therapy," Dr. Boardman said. "The findings of this Cochrane review need to be carefully considered. This is a complicated health issue, where the same treatment offers benefits in some women, but harms in others.”

Altogether, Dr. Boardman and team looked at data on more than 40,000 women from different countries. Women in the trials might have taken HRT for as little as seven months or as long as 10 years.

Dr. Boardman and colleagues found no evidence that HRT protects women from heart attacks, stroke, angina or death from heart disease.

HRT protected neither healthy women nor women who already had heart problems, these researchers found. In fact, postmenopausal women had a slightly increased risk of stroke after using HRT.

Timing of HRT did appear to matter, however. Women in this study who started HRT within the first 10 years of menopause had a little protection from death and heart attacks.

These women did not have an increased risk of stroke. The early HRT users did have a slightly increased risk of deep vein thrombosis — blood clots in the leg.

All the trials compared HRT in the form of estrogen — the major female sex hormone — with a placebo, or sugar pill. In some cases, the HRT included both estrogen and progesterone, the second major female sex hormone.

“Hormone therapy remains a valid treatment option for women who are significantly troubled by menopausal symptoms, however the risks and benefits of such treatment vary according to age and medical history," Dr. Boardman said. "Discussion with your [doctor] is recommended when considering treatment.”

This study was published online March 10 in the Cochrane Database for Systematic Reviews.

The UK Cochrane Centre and the UK National Institute for Health Research funded this research. The authors disclosed no conflicts of interest.

Review Date: 
March 9, 2015